• Coping With the Loss of a Limb

    Image for loss of limb article Some people are born with a limb difference, for others it is the result of injury or disease such as diabetes, and peripheral vascular disease (PVD). Regardless of the cause, losing all or part of a limb is a life-changing event that can cause grief and decreased self-esteem.

    Grieving

    When you lose a limb, you lose part of your physical self. Grieving, therefore, is both normal and expected. There are five stages of grieving that people commonly go through after a serious loss:
    • Denial and isolation
    • Anger
    • Bargaining
    • Depression
    • Acceptance and hope
    How long it takes a person to pass through these stages varies. Many pass through each phase quickly; others get stuck in one phase or go through one phase without going through the others. Also, stages can occur in different order.
    According to a study in the journal Behavioral Medicine, a person’s age, the site of limb loss, and the cause of amputation all affect how an individual copes with losing a limb. For example, people who lose their limb unexpectedly may be more likely to react with denial (characterized by the refusal to accept the situation and its impact on well-being) than an individual whose amputation was the result of a long-term disease. Furthermore, people in denial are less likely to seek the help they need to move towards the final stage of acceptance and hope.

    Body Image

    The loss of a limb can have a serious negative impact on a person’s body image. Children, for example, may feel “different” from their peers. Adults may find that their negative self-image affects their sexual relationships. Research has shown that when faced with a disfiguring medical condition, people who feel self-conscious about their disfigurement respond by avoiding social situations. Unfortunately, this can trigger depression. If you are feeling self-conscious about your limb loss, try to remember that your physical appearance does not matter to those who care about you.

    Phantom Sensation and Phantom Limb Pain

    Phantom sensation is the sensory experience that the amputated limb is still present. It is natural to have that feeling and it occurs in most amputees. Phantom pain on the other hand is often described as intense twisting, burning, and shooting pain within the amputated limb. The higher the intensity and duration of a painful condition before the loss of the limb, the higher risk of phantom pain, which makes the pain control prior to limb loss a crucial issue.

    Taking Action

    While grieving is a normal part of coping with limb loss, getting stuck there is not. Here are some steps you can take to help get through this difficult period.
    • Seek help. Let your family and friends help you out. This may be difficult because they do not know exactly what you are experiencing, but give them a chance. You may even help them by communicating your needs.
    • Exercise. The traditional benefits of exercising—strength, flexibility, and cardiovascular endurance—all still apply to a person with limb loss. Improving your balance and coordination and increasing circulation are especially helpful for regaining physical functioning. Research shows that exercise can help you learn to love and respect your body again. A study in the American Journal of Physical Medicine and Rehabilitation found that people with lower limb amputations were more likely to have a positive body image if they regularly participated in physical activity.
    • Talk. One of the first strategies when coping with limb loss is to talk with another amputee who has undergone a similar situation. They have been through it and can offer a different point of view than your nonaffected friends or family. Whenever possible, this should also be done before limb removal to help mentally prepare you for what lies ahead. Ask your doctor or physical therapist if they know of someone in your situation who you might be able to talk to. Or turn to a local or online support group. For more support, or in the case of clinical depression, there is professional therapy. Your doctor can provide you with a referral to a social worker or psychologist.
    • If possible, go back to work. Returning to work will help you rebuild your sense of self and purpose. A study in the International Journal of Rehabilitation Research interviewed 100 people who had sustained a lower limb amputation within the previous year and found that two out of three had returned to work.

    Achieving a Sense of Well Being

    In the end, it is important to realize that although you may have lost a part of you, it does not change who you are. If you don’t already, you will soon realize the truth of the age-old saying, "beauty comes from within." Losing a limb may actually help let what you have on the inside shine through. You are still the same person, with the same mind and soul.

    RESOURCES

    Amputee Coalition of America http://www.amputee-coalition.org/

    Amputee Resource Foundation of America http://www.amputeeresource.org/

    CANADIAN RESOURCES

    Amputee Coalition of Canada http://amputeecoalitioncanada.org/

    The College of Canadian Family Physicians http://www.cfpc.ca/

    References

    Fisher K, Hanspal RS, Marks L. Return to work after lower limb amputation. Int J Rehabil Res. 2003;26(1):51-56.

    Gallagher P, MacLachlan M. Psychological adjustment and coping in adults with prosthetic limbs. Behavioral Medicine. 1999;25(3):117-124.

    Smith DG. Facing Amputation: Questions to ask your surgeon and rehabilitation team. First Step: A Guide for Adapting to Limb Loss. 2003;3:7-11.

    Wetterhahn KA, Hanson C, Levy CE. Effect of participation in physical activity on body image of amputees. Am J Phys Med Rehabil. 2002;81(3):194-201.

    Williamson GM. Living with limb differences: building self-esteem. First Step: A Guide for Adapting to Limb Loss. 2001;2:72–73.

    Weinstein, SM. Phantom pain. Oncology. 1994;8(3):65-70.

    van der Schans CP, Geertzen, JH, Schoppen, T, Dijkstra, PU. Phantom pain and health-related quality of life in lower limb amputees. J Pain Symptom Manage. 2002;24(4):429-436.

    Flor, H, Elbert, T, Knecht, S, et al. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995;375:482.

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